Provider Demographics
NPI:1326165200
Name:SULLIVAN, HEATHER STONE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:STONE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1149
Mailing Address - Country:US
Mailing Address - Phone:781-367-1841
Mailing Address - Fax:
Practice Address - Street 1:5 N MEADOWS RD
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2317
Practice Address - Country:US
Practice Address - Phone:508-359-9119
Practice Address - Fax:508-359-9115
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000150102OtherMEDICARE PTAN
MA497216OtherTUFTS